The Scottish Government’s Programme for Government 2026-31 includes a plan to reduce the current 14 territorial health boards to two. This briefing examines the proposal and its consequences.
The driver is efficiency savings, and we explain that this is unlikely, at least in the short term. NHSScotland is already highly centralised, with no local democratic accountability. Having two health boards effectively removes local input from service delivery, leaving them as central government departments.
While acute hospital services could be managed on a three- or four-health-board model, community services cannot. We set out the options: none of which are ideal. They also require the reform of social care and local government, which has yet to be decided.
We conclude that public service reform is rarely as straightforward as it initially looks. Reducing the number of health boards could deliver financial savings, although not quickly. However, it also requires other structural decisions, particularly around social care and local government. Restructuring to cut costs ignores the key point of the Christie recommendations – focus on outcomes. More centralisation is rarely the right solution.